State lawmakers again added more health insurance mandates to the books in 1999. These mandates tell insurers what services, providers and persons they must cover in a plan offered in a given state. According to a survey:

• There were 1,391 such mandates in all 50 states at the end of 1999, compared to just five mandates in 1968.

• In one year, from the end of 1998 to the end of 1999, the number of mandates increased 9.4 percent.

• Of the mandates currently on the books, 677 mandate certain benefits, 444 mandate the coverage of specific providers, 241 mandate specific persons that must be covered and 29 mandate coverage for specific procedures.

The hot issues for mandates in 1999 were mental health coverage (also known as mental health parity) and coverage for insured people who chose to participate in certain clinical trials. Although a number of legislatures also addressed cost and impact requirements for future mandates, only four adopted any legislation on these issues.

Experts have warned that the continued addition of mandates drives up the cost of health insurance and forces a number of lower-income families to drop their health insurance.

Source: "1999 Survey of Health Plans, State Legislative Health Care and Insurance Issues," BlueCross BlueShield Association, 1310 G Street NW, Washington DC, 20005.